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- � � __---- - ___ ---- - <br /> ,�---- --- -- -- --PERMIT APF'LICATION �`>c��;c��� <br /> CITY OF EVERETT PERMIT SERVICE� ,',��•t. � <br /> 3200 CEDAR STREET, EVERETT, We esetotwa.org <br /> I 425-257-8810- FAX 425-257-8857 -wWW �,I <br />;!>.;�; 'i APPLICATIONS ARE ACCEP7ED FROM S AM 70 4 PM P � <br /> � PARCELTAX I.D.# � /.��2 / �II <br /> � SITE 4DDRESS _ � U <br /> .�l/U `-�� �v�/¢ ��- Nb�� w� �U. � � U3 <br /> BLOCK TRACT <br /> LEG.�L LOT NO. _ L �,j. i� pHONE <br /> DESC, CITVIZIP <br /> ADDRESS 5.�,�,Q�GZ <br /> � OWNER v L�I��� <br /> iYP�'¢YI' �•^^�� d� '"'�c�2 �I�rj I�G /G�}1 An�—l� 4.I^,��f�Jt�' PHONE <br /> I CONTACTFORPERMIT i�ZS_ �G�-� L�37Z <br /> I 7ENANT NAME ^'��� n/�,q s� <br /> I S �NS✓��MG� _D 'J PHONE <br /> �i-,riv�e✓ amziP , �,z z� <br /> ADDRESS ' 1 � I ;.�yj-�iJf�3 i <br /> �'i CONTRACTOR ��c�l =��C_. 9�,3v Iy3;�G'�'� �� �/`'t,-cv.t7 I <br /> i ,�.�;�- /h"-�- °t�t,SZ <br /> , cON�.LI�Y# \� ��3U1� CONTRACT PRI�OF WORK <br /> I HEATSOURCE / !� <br /> ��I USEOFBUILDING Gas_Olher I�C�vVO� <br /> .-�//y�/�`G� Eleciri� ____—�� I <br /> I� V�'�" -�� I � � h� `�1�5�4 � 1 � <br /> I �� <br /> �I WORKDESCRIPTION � �. Ov�� �''�� '`� ' tiS 5��� W�.�-y (�LcF4/. ����jL <br /> Q,`Occ_ E ` `j^ v'` �� <br /> � Cl/�� lne.W <br /> �OIl�.Y' �_..+ <br /> I MECHANICAL <br /> PLUMBING N� 7ypE OF FIXTURE OR ITEM <br /> ' ND TYPE OF FIXTURE OR ITEM p��_air handling units <br /> Toilel _ Forced air systems <br /> — BathWb Gas P�P��9 , �� S4I/N <br /> '� _ � Water heater <br /> Lavatory(wash basin) Gas freplace <br /> Shower — Gasrange <br /> !I � Kitchen sink&disposal — Clolhes dryer <br /> Dishwasher — Range hood <br /> Clothes washer — Exhaust fan I <br /> ' — Laundry tray — Heat pump <br /> Slnk(servicelbar/mopletc.) — Unitheater <br /> �. — Backtlow preventer — Boiler <br /> �, Urinal — RQ(rigeration <br /> Drinking Founlain — Woodstove �I. <br /> i -- n <br /> Floor drai — <br /> i Other ��— <br /> —� Grease trap — — I I <br /> I' Roof drains — I <br /> �� -- Other�--- —�— —'—"— I I <br /> I � <br /> II� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> II hereby cenlify that I have read and examined this application and know the same to be true and correct. All provisions of laws an <br /> to erfortn lhe work for which applicalion is made and I cemply with the I�i <br /> �� ordinaces governing lhis type of work will be complied with whether specified herein or noL The granting of a pertnit does nol presum <br /> to give authorThat I am au hor zed by therowner of iti s p�ropeAy`al p r local iaw regulating conslructlon or the perfortnance of <br /> Iconstruction. ��I <br /> State Conlractors Law 1827 RC� d z96200 WAC. 7 } <br /> t, � �' Date <br /> �' Signa�t e of Own�ontraclorl ut urize Agent ....---_--. . ..I�', ,�. <br /> ' --------- - - - i <br /> ---- <br /> -- - - - -.._.. . .. , <br /> r <br />